The Netherlands was not well prepared for a protracted, national health crisis. The country’s crisis structure and crisis communication proved to be inadequate. People from all sectors involved in tackling the crisis worked hard and in difficult circumstances. But the effort put in by so many does not detract from the fact that improvements in the crisis approach are both possible and necessary. This is the conclusion reached by the Dutch Safety Board in its report Approach to COVID-19 crisis, Part 1, published today. The research report examines the Dutch preparations for a pandemic and the approach taken during the first six months of the crisis. “The COVID-19 crisis touched people’s lives throughout the world. Here, the health crisis spilled over into the biggest social crisis we have seen in decades,” says Jeroen Dijsselbloem, chairman of the Dutch Safety Board. “The Netherlands proved to be vulnerable. This was due to the structures the government had in place for the health sector and the crisis response: they fell short given the nature and scope of the crisis.”
Improvising in an unprecedented crisis
The government and its advisors tried in various ways to minimize the uncertainties presented by this crisis. The lack of knowledge about the virus and the limitations of the testing policy in place in the investigated period meant that information on the spread of the virus and the effectiveness of the chosen approach was not sufficiently clear. Signals about social effects such as loneliness were snowed under in the advisory and decision-making process. “Dealing with uncertainty is part of a crisis,” Jeroen Dijsselbloem observes. “Advisors should not filter out uncertainties, but should rather put them forward to decision-makers including encouraging or disappointing scenarios. This is the only way decisions can be taken, and scenarios can be prepared in a timely manner.”
The Dutch government based its decisions on the advice of the Outbreak Management Team (OMT). This was a conscious decision. But it also meant that the Dutch focus during the first wave in the crisis of COVID-19 infections became overly fixated on the hospitals. Little attention was paid to the other effects of a crisis that was having an unprecedented impact on nursing homes, education, cultural institutions, and small and medium-sized businesses, among other sectors. These effects turned the health crisis into a wider social crisis. The Dutch Safety Board concludes that the government could have improved the effectiveness of its crisis response by making a greater effort to look further ahead and by seeking advice on a wider range of issues than the effects of the virus on acute care.
Limited government communication
During the early months of the pandemic, there was broad public support for the government’s approach. This decreased as the crisis continued. The government’s message failed to reach some groups in society, many of whom did not feel heard or did not agree with how the crisis was being handled. The Dutch Safety Board highlights the one-sided approach to crisis communication and argues that the government should engage more with citizens about their concerns and their needs. By being clear about what is or is not known about the course of the crisis while being less insistent, the government can avoid creating unrealistic expectations among the public about what the future might bring.
This study takes a particularly close look at how the government’s approach to the crisis impacted on nursing homes. In the early stages of the crisis, all eyes were directed towards acute care and hospitals, and the government only had a limited view of the effects on non-acute care. The Board concludes that, as a result, the impact of the crisis on staff and residents in nursing homes was not adequately incorporated in the decision-making process. Despite the government’s stated goal of protecting the vulnerable in society, the focus was on the vulnerable COVID-patients in hospitals. Scant attention was given to the protection of vulnerable elderly people in nursing homes during the first period. This had serious consequences. It meant that initially protective equipment was primarily made available to hospitals and acute care, and not to nursing homes. When the gravity of the situation in nursing homes became clear, the government issued a ban on visits at the request of the nursing home sector. The social and psychological impact of this measure was keenly felt, leading to loneliness and in some cases denying family members the opportunity to say goodbye to loved ones who lost their lives. The Board speaks of a “silent disaster”: about half of the COVID-related deaths in the Netherlands up to September 2020 were nursing home residents.
Learning lessons for the future
From the numerous interviews conducted by the Dutch Safety Board, it is clear that, across all sectors, those involved in combating the crisis worked hard, while also coping with the effects that the crisis and the Covid measures were having on their private lives. Despite the tremendous resilience that the Board has seen, it is essential that the Netherlands looks closely at the early stages of the pandemic and learns lessons for the future. Because the responsibility for dealing with the COVID-19 crisis lies with the government, the Board addresses all of its recommendations to the government: Strengthen crisis preparedness within government by further developing scenarios and formulating the effects of those scenarios in greater detail. Develop the capacity to improvise. Adapt crisis structures by incorporating an implementation assessment and by considering long-term implications alongside an acute crisis-approach as part of the decision-making process. Ensure that you have an accurate and up-to-date view of the crisis and a good sense of the effect measures will have. Be acutely aware of the needs of vulnerable groups and monitor the approach to make sure that it is working for them. Lastly, when tackling a crisis, there should be a clear separation between the role of the advisors (the experts) and the role of the decision makers (the government officials). The government and parliament should explicitly make and account for the far-reaching considerations they sometimes inevitably have to make in very difficult circumstances in a crisis.